Early Transcatheter Aortic Valve Replacement Significantly Reduces Cardiovascular Events in Asymptomatic Patients

Recent findings from the EARLY TAVR trial highlight the benefits of performing transcatheter aortic valve replacement (TAVR) early in patients with asymptomatic severe aortic stenosis. The study revealed that patients aged between 65 and 70 years derive the greatest advantage, especially in decreasing stroke risk and the combined endpoint of death, stroke, or heart failure hospitalization. These results were unveiled at the 2025 Scientific Sessions of the Society for Cardiovascular Angiography & Interventions (SCAI).

Aortic stenosis, a condition characterized by narrowing or blockage of the heart’s aortic valve, affects approximately 300,000 Americans annually. Managing asymptomatic severe cases traditionally involves either vigilant clinical surveillance, monitoring the patient closely and only intervening when symptoms appear, or opting for immediate aortic valve replacement.

The EARLY TAVR trial, a robust randomized controlled study, demonstrated that opting for early TAVR was superior to clinical surveillance in reducing death, stroke, and unplanned cardiovascular hospitalizations. The trial involved 901 patients with asymptomatic severe aortic stenosis, randomly assigned to early TAVR (455 patients) or surveillance (446 patients), with an average follow-up of about 3.8 years. Both groups had similar baseline health conditions.

The data indicated that age plays a significant role in outcomes, with older patients experiencing higher rates of adverse events. Nonetheless, all age groups benefited from early TAVR, with the most notable improvements observed in the 65-69 age bracket. Specifically, these patients experienced a drop in stroke incidence from 13% with surveillance to 0% with early TAVR, and a sixfold reduction in the combined event rate of death, stroke, or heart failure hospitalization.

Patients over 80 years also benefited considerably, particularly in stroke reduction, with a fourfold decrease in stroke risk over five years post-procedure. Dr. Philippe Genereux, lead investigator of the trial, emphasized that these results underscore the importance of early intervention regardless of age, especially for younger seniors, given the notable stroke risk associated with untreated aortic stenosis.

This research suggests that early TAVR may become the preferred strategy for managing asymptomatic severe aortic stenosis, potentially altering current clinical practices by advocating for earlier intervention to improve long-term cardiovascular outcomes.